Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

Abstract

Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

Efficacy and Safety of Transcranial Electric Stimulation during the Perinatal Period: A Systematic Literature Review and Three Case Reports

“…In addition, several authors point out that transcutaneous electrical nerve stimulation (TENS), with a strength of 100 mA, has been used safely in pregnancy for decades as pain relief during labor [ 49 , 68 ]. Compared to tES techniques, repetitive transcranial magnetic stimulation (rTMS) has been more widely studied in the perinatal period [ 57 , 58 , 69 , 70 , 71 ]. Kurzeck et al [ 56 ] emphasized that follow-up examinations of children exposed to rTMS during pregnancy revealed no delay in cognitive or motor development [ 26 ].…”

Effects of Transcranial Pulse Stimulation (TPS) on Adults with Symptoms of Depression—A Pilot Randomized Controlled Trial

“…In the last decade, there have been some other treatment approaches using nonintrusive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) [11] and transcranial magnetic stimulation (TMS) [12,13], as well as repetitive transcranial magnetic stimulation (rTMS) [14], in the treatment of depression. The recent development of a new type of NIBS called 'transcranial pulse stimulation' (TPS), also known as lowintensity extracorporeal shock wave therapy (Li-ESWT), has been proven effective for only a 2-week treatment of 35 patients with Alzheimer's disease (AD).…”

Depressionen in der Schwangerschaft

“…Insgesamt zeigen sich aber Hinweise auf eine Überlegenheit der rTMS zur Behandlung depressiver Symptome in der Schwangerschaft gegenüber einer Scheinbehandlung bzw. einer Wartelistenkontrollgruppe und keine relevanten Nebenwirkungen sowie keine negativen Auswirkungen auf die exponierten Kinder, auch nach 5 Jahren nicht [35,36].…”